LGBTQ Mentor Application

First Name*

Last Name*

UND E-mail*

Phone Number *

What is your gender identity or gender expression?

e.g.; Male, Female, Transgender Male/Masculine, Transgender Female/Feminine, Non-binary, Gender Non-conforming, Genderqueer

What is your sexuality?

e.g.; gay, lesbian, bisexual, pansexual, asexual, aromantic, demisexual, demiromantic

What is your UND Affiliation *

Which department do you work?

To be completed by faculty/staff mentors.